|
|
Letter
Leptotrichia amnionii
and the Female Reproductive Tract
Vijay A.K.B. Gundi,* Raoul Desbriere,† and Bernard La Scola*
*Unité des Rickettsies, Marseille, France; and †Hôpital Nord, Marseille,
France
Suggested
citation for this article
To the Editor: Detection of new bacteria, human complex microflora,
by using 16S rRNA gene amplification and sequencing has been reported
(1). 16S rRNA gene amplification and sequencing detected
pyosalpinx, caused by Leptotrichia amnioni, in a patient whose
samples were culture-negative.
This anaerobic gram-negative bacterium has been isolated only once before
(2). A 41-year-old woman from the island of Comoros who
had been having lower abdominal pain for 6 days was admitted to the emergency
department of Hôpital Nord in Marseille. The patient's history included
type 2 diabetes mellitus treated by metformin and laparoscopy to explore
infertility. On examination, the patient had a pulse rate of 90 beats
per min, a blood pressure of 130/80 mm Hg, and a temperature of 38.5°C.
Her abdomen was not distended, but diffused lower abdominal tenderness,
especially at the right iliac fossa, was present. Blood testing showed
a leukocyte count of 7.7x109/L, hemoglobin of 13.1g/dL, and
platelet count of 213x109/L. The chemistry panel showed hyperglycemia
(14.1 mmol/L) and elevated C-reactive protein (254 mg/L). Renal and liver
function test results were all within normal limits. Serum β-human
chorionic gonadotropin was negative. A computed tomographic scan of the
abdomen and pelvis showed two septated adnexal masses, a 12x7x5 cm mass
on the right and a 6x4x2 cm mass on the left; the patient was referred
to the gynecologic surgery department. Gynecologic examination showed
greenish, purulent vaginal discharge and a fluctuant mass in the pouch
of Douglas. Uterine cervical motion caused pain to the patient. Transabdominal
and transvaginal ultrasound scan showed a 10x7x5 cm homogeneous liquid
mass in the pouch of Douglas.
The patient was taken to the operating room and prepared for surgery.
The gynecologic team performed a laparotomy that showed a 5-cm, left hydrosalpinx
and a 10-cm, right tuboovarian abscess adherent to the uterus, sigmoid
colon, pelvic sidewall, and pouch of Douglas. The appendix and other viscera
were normal. The adhesiolysis led to the rupture of the abscess and discharge
of clear greenish pus, a sample of which was sent to the laboratory for
culture. Antimicrobial drug treatment was started with intravenous cefazolin,
gentamicin, and metronidazole. On the first postoperative day, the patient
was afebrile. Oral amoxicillin plus clavulanic acid was administered for
15 days, and oral ciprofloxacin was administered for 20 days. The patient
was discharged on day 7 of hospitalization and was well at the follow-up
examination 1 month later.
After Gram staining, a sample of the abscess drainage was injected onto
Columbia agar with 5% sheep blood (bioMerieux, Marcy l'etoile, France)
under 5% CO2 and anaerobic atmosphere. Antimicrobial susceptibility
of the sample was tested by an agar diffusion method (3).
A drop of the sample was deposited on an agar plate flooded with a suspension
of a antimicrobial susceptible strain of Micrococcus luteus. After
24 h of incubation at 37°C, presence of antimicrobial activity in the
sample was evident by a visible area of growth inhibition of M. luteus
around the sample. Procedures for DNA extraction and16S rRNA gene amplification
and sequencing have been detailed (4).
Gram staining of the sample showed numerous polymorphonuclear leukocytes
and gram-negative bacteria. Culture of the sample remained sterile after
20 days of incubation, and antimicrobial susceptibility was found. The
16S rRNA gene amplification and sequencing determined a 1,493 nucleotide
sequence. This sequence had 99.7% nucleotide similarity with that of L.
amnionii (GenBank accession no. AY078425), which corresponded to a
difference of 4 nucleotide. The 16S rRNA gene sequence of the detected
bacterium was deposited under accession no. AY489565. L. amnionii
was previously recovered in anaerobic culture of the amniotic fluid of
a woman after intrauterine fetal demise (2). It was isolated
on blood and chocolate agar under anaerobic conditions and showed very
small gray colonies of <1 mm. This slow-growing bacterium was lost
after two subcultures, and no isolate is available for further description
(2). In that case and in the case reported here, the
patients had uneventful recoveries after an amoxicillin plus clavulanic
acid antimicrobial regimen was given. This bacterium and our isolate are
related to, but different from, L. sanguinegens.
Leptotrichia is a small genus closely related to Fusobacterium
and comprises slow-growing, gram-negative, filamentous, anaerobic bacterial
flora of the oral cavity and genital tract (5). Species
included in the genus are L. buccalis, L. trevisanii, L.
sanguinegens, and L. amnionii (2,6). All Leptotrichia
species are extremely fastidious and cannot be grown easily on conventional
microbiologic media or by conventional methods. As evidenced by sequences
available in the GenBank database, most of the 16S rRNA gene sequences
are from cloned DNA from complex flora but not from bacterial isolates.
Leptotrichia species has been suspected to play a role in periodontal
disease. However, Leptotrichia species have only been associated
with serious systemic disease, usually in immunocompromised patients (7,8).
Bacteremia caused by L. sanguinegens in pregnant women has also
been reported (9). More widespread use of polymerase
chain reaction amplification and sequencing of the 16S rRNA gene for identification
or detection of fastidious pathogens in humans will likely provide verification
of several new pathogens that are now part of normal human flora.
References
- Leys EJ, Lyons SR, Moeschberger ML, Rumpf RW, Griffen
AL. Association
of Bacteroides forsythus and a novel Bacteroides phylotype
with periodontitis. J Clin Microbiol. 2002;40:821–5.
- Shukla SK, Meier PR, Mitchell PD, Frank DN, Reed KD. Leptotrichia
amnionii sp. nov., a novel bacterium isolated from the amniotic
fluid of a woman after intrauterine fetal demise. J Clin Microbiol.
2002;40:3346–9.
- Zannier A, Drancourt M, Franceschi JP, Aubaniac JM, Raoult D. Interest
of the centrifugation lysis method for bacterial isolation from bone
and joint specimens [article in French]. Pathol Biol (Paris). 1991;39:543–6.
- Raoult D, Birg ML, La Scola B, Fournier PE, Enea M, Lepidi H, et al.
Cultivation
of the bacillus of Whipple's disease. N Engl J Med. 2000;342:620–5.
- Holt JG, Kreig NR, Sneath PH, Staley JT, Williams ST. Bergey's manual
of determinative bacteriology. 9th ed. Baltimore: Williams & Wilkins;
1994.
- Collins MD, Hoyles L, Tornqvist E, von Essen R, Falsen E. Characterization
of some strains from human clinical sources which resemble "Leptotrichia
sanguinegens": description of Sneathia sanguinegens
sp. nov., gen. nov. Syst Appl Microbiol. 2001;24:358–61.
- Weinberger M, Wu T, Rubin M, Gill VJ, Pizzo PA. Leptotrichia
buccalis bacteremia in patients with cancer: report of four cases
and review. Rev Infect Dis. 1991;13:201–6.
11783691
- Tee W, Midolo P, Janssen PH, Kerr T, Dyall-Smith ML. Bacteremia
due to Leptotrichia trevisanii sp. nov. Eur J Clin Microbiol
Infect Dis. 2001;20:765–9.
- Hanff PA, Rosol-Donoghue JA, Spiegel CA, Wilson KH, Moore LH. Leptotrichia
sanguinegens sp. nov., a new agent of postpartum and neonatal bacteremia.
Clin Infect Dis. 1995;20(Suppl. 2):S237–9.
Suggested citation
for this article:
Gundi VAKB, Desbriere
R, La Scola B. Leptotrichia amnionii and the female reproductive
tract [letter]. Emerg Infect Dis [serial on the Internet]. 2004 Nov [date
cited]. Available from http://www.cdc.gov/ncidod/EID/vol10no11/03-1019.htm
|
